Healthcare Provider Details

I. General information

NPI: 1477953750
Provider Name (Legal Business Name): TOD ZWAHLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2014
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N CARPENTER RD STE C16
MODESTO CA
95351-1156
US

IV. Provider business mailing address

3067 E WARM SPRINGS RD STE 100
LAS VEGAS NV
89120-3750
US

V. Phone/Fax

Practice location:
  • Phone: 209-602-3554
  • Fax:
Mailing address:
  • Phone: 702-650-6508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: